Individual provider · Type 1 NPI

Mallory R. Waltrip, APRN

Gerontology Nurse Practitioner · Springfield, IL

NPI number 1780125278 Active

Practice location

900 N 1st St
Springfield, IL 62702-3749

Mailing address

1025 S 6th St
Springfield, IL 62703-2403

Specialties and licenses

TaxonomyCodeLicense
Adult Health Nurse Practitioner 363LA2200X209015762 (IL)
Gerontology Nurse Practitioner Primary 363LG0600X209015762 (IL)

Gerontology Nurse Practitioner: Definition to come...

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About NPI 1780125278

Mallory R. Waltrip, APRN's National Provider Identifier is 1780125278, issued on Mar 16, 2017. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Springfield, IL. The record was last updated on Apr 7, 2026.